The American College of Surgeons Oncology Group (ACOSOG) is dedicated to improving the care of the surgical oncology patient through an innovative clinical research program addressing three specific aims: 1. To test novel therapies that may increase response rates and cure rates and reduce morbidities and disabilities associated with cancer care. 2. To conduct basic science studies in conjunction with clinical trials to better understand the biologic basis of diseases and treatments. 3. To support individual members and investigator networks to accrue patients to trials and fulfill the scientific mission of ACOSOG. The scientific portfolio of ACOSOG is focused on investigations specific to molecular and image profiling, neoadjuvant therapies, and targeted or novel surgical therapies. There are four scientific committees including a Basic Science Committee and three disease committees: Breast, Gastrointestinal (GIST, pancreas, and rectum) and Thoracic (lung and esophagus). Three scientific aims are described for ACOSOG trials including: a) to enhance risk stratification by increasing the accuracy of prognostication through imaging and molecular profiling;b) to improve overall response rates and monitor individual responses through the application of neoadjuvant therapies;and c) to investigate novel, targeted, and surgical therapies to maintain oncologic outcomes while Individualized Response Monll reducing toxicities and disabilities thereby improving quality of life. To set the scientific agenda of ACOSOG, the disease committees work with the Basic Science Committee to ensure, where appropriate, the development of science-driven trials. The scientific committees also work closely with the administrative committees &the Peer-Review and Prioritization Committee to ensure membership support as well as prioritization, coordination, and quality science. All disciplines as well as Nursing &Patient Advocates are represented and provide protocol feedback through the Peer-Review Committee process. The Basic Science Committee &ACOSOG Biospecimen Bank ensure the appropriate acquisition and storage of samples to conduct the scientific studies integrated into each clinical trial. To accomplish the scientific aims, ACOSOG conducts clinical trials using an infrastructure consisting of five critical components, including the: 1) Administrative Coordinating Center (ACC or Operations Office) located in Durham, NC within the Duke Clinical Research Institute;2) Biostatistics, located in Rochester, MN, within the Mayo Clinical Cancer Center;3) Leadership, both scientific and organizational;4) Membership and Networks;and 5) the Biospecimen Bank located in St. Louis, MO, within Washington University.